BRIDGE TO THE DOCTORATE PROGRAM APPLICATION INSTRUCTIONS

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1 BRIDGE TO THE DOCTORATE PROGRAM APPLICATION INSTRUCTIONS These instructions & all required forms are available Temple University Bridge to the Doctorate Fellowships support qualified, minority students beginning graduate studies in STEM fields in The STEM fields are Science, Technology, Engineering and Mathematics. Qualified minority students entering the following Temple University degree programs are eligible for support via a Bridge to the Doctorate Fellowship: PROGRAM / DEGREE OFFERINGS GRID PROGRAM DOCTORATE MASTER S Biology Yes Yes (M.S.) Chemistry Yes Yes (M.A.) Civil Engineering X Yes (M.S.E.) Computer & Information Science Yes Yes (M.S.) Electrical Engineering X Yes (M.S.E.) Engineering Yes X Geology X Yes (M.S.) Mathematics Yes Yes (M.A.) Mechanical Engineering X Yes (M.S.E.) Mechanical Engineering (Bioengineering concentration) X Yes (M.S.E.) Physics Yes Yes (M.A.) Choose one of these programs for item #12 in the form Application for Graduate Study (Attached) Bridge to the Doctorate Program Requirements Applicant must be a US Citizen or US Permanent Resident Must be an Underrepresented Minority Student (Ethnicity = African American, Native Hawaiian or Pacific Islander, Hispanic or Latino, Native American Indian) OR have been involved in a Louis Stokes Alliance for Minority Participation program as an undergraduate Should have a GPA of minimum 3.00 in junior & senior years or institutional recomendation (Faculty / AMP Representative) Degree or prospective degree from a Louis Stokes Alliance for Minority Participation institution GRE (taken prior to matriculation) Page 1 / 3

2 Application Instructions These instructions & all required forms are available Application Process Please complete the following forms attached to this document: a.) Bridge to the Doctorate Program Application b.) Application for Graduate Study Application Deadline August 10, No Application Fees required 4. Please apply early. Admissions are competitive and will be on a rolling basis 5. Applicant will be notified by that application was received 6. The College of Engineering or Science & Technology will send the applicant: a.) Official letter of acceptance b.) Intent to Enroll Form 7. The Director of Philadelphia AMP Bridge to the Doctorate will send the applicant an acceptance letter for the Bridge to the Doctorate Program and the Memorandum of Understanding Forms 8. Applicant will return the Intent to Enroll Form and the Memorandum of Understanding to the respective program department office listed on page 3 9. The following documents must be submitted: Bridge to the Doctorate (BTD) Application: Completed and Signed Bridge to the Doctorate Program Application (Attached) If student is a Permanent Resident, a copy of Resident Alien card should be attached to the BTD Application Temple University Application: Completed & Signed Temple University Application for Graduate Study (Attached) Official transcript Standardized test scores if available: GRE (TOEFL - if not native speaker of english) Statement of goals Three Letters of reference: a.) Temple University reference report can be downloaded from the website b.) Evaluators must send their completed reference report directly to the respective program department office listed on page 3 Page 2 / 3

3 Application Instructions These instructions & all required forms are available 8. Completed applications including all required documents (Please Refer page 2) must be submitted to the respective program / department office listed below: PROGRAM Biology Regee Neely Chemistry Jason Pfeffer Civil Engineering Electrical Engineering Engineering Mechanical Engineering Mechanical Engineering (Bioengineering concentration) Donald Heller Computer & Information Science Karen Woods-Wilson Geology Shelah Cox Mathematics Kathleen Paul Physics Evelyn Washington APPLICATION MAILING ADDRESS Department of Biology Rm 255 Biology-Life Sciences Bldg N. 12th Street Department of Chemistry Rm 103 Beury Hall, 1901 N. 13th Street College of Engineering Rm 332 Engineering Bldg N. 12th Street Department of CIS Rm 324 Wachman Hall 1805 N. Broad Street Department of Geology Rm 303 Beury Hall, 1901 N. 13th Street Philadelphia PA Department of Mathematics Rm 638, Wachman Hall, 1805 N. Broad St. Philadelphia, PA, Department of Physics Rm A116 Barton Hall, 1900 N. 13th Street Philadelphia PA Page 3 / 3

4 BRIDGE TO THE DOCTORATE PROGRAM APPLICATION Type or print in black ink Degree Program Applying For (Refer Page 1 of Application Instructions) Applicant Information Name (Last, First, Middle Initial) Phone Home / Permanent Address Local Mailing Address (If Different) City, State, Zip City, State, Zip US Citizen: Eligible Minority Group: (Check all that apply) Yes No African American Hispanic or Latino Permanent Resident (If Non-US Citizen): Yes No Native American Indian Native Hawaiian or Pacific Islander ** ** Note: A person having origins in any of the original places of Hawaii, Guam, Samoa, Polynesia, Micronesia, or other Pacific Islands Educational Background Undergraduate Institution Major Cumulative GPA GRE Scores (Please attach copy) Math: Verbal: Analytical: Have you applied for or been awarded other graduate fellowship support? Yes No If yes, please indicate: Source of Support: Amount of Support: Page 1 / 2

5 Bridge to Doctorate Program Application Type or print in black ink Alliance for Minority Participation Director (Applicant s Undergraduate Institution) Name of AMP Program Director ( Last, First, Middle Initial) Institution Department Phone Research Experience (Please List if applicable) Name of Advisor / Lab Name of Project Duration Please read the following carefully and sign only if you are in agreement: I certify that I m an US Citizen or Permanent Resident I certify I m an Underrepresented Minority Student (Ethnicity = African American, Native Hawaiian or Pacific Islander, Hispanic or Latino, Native American Indian) OR have been involved in a Louis Stokes Alliance for Minority Participation program as an undergraduate I agree that I am committed to the pursuit of a graduate degree I agree that this program will be considered full-time employment and that I cannot be employed by any other agency I certify that I am not currently and have not previously enrolled in a STEM graduate program I understand that I will not be allowed to continue in the Bridge to the Doctorate Program if my academic progress does not meet Temple University requirements, including maintenance of a 3.0 GPA I understand that my eligibility to continue in the Bridge to the Doctorate Program is contingent upon my enrollment in a STEM field I hereby certify that all statements in this application are true to the best of my knowledge & understanding Signature of Applicant: Date: Page 2 / 2

6 Application for Graduate Study Instructions: Type or print legibly using dark blue or black ink. Enclose the $50.00 application fee by check or money order made payable to Temple University. Mail directly to the appropriate department/program. Temple University requests your Social Security number (SSN) because federal, state, and local law require the University to report the name, address, and SSN for certain purposes. Temple University will not disclose your SSN without consent unless it is required to do so by law, or as permitted by the University s Social Security Number Usage Policy ( Social Security Number Country of Citizenship 3. Full Legal Name 4. Prior Name(s) Used (if any) LAST/SURNAME/FAMILY NAME FIRST MI 5. Date of Birth* 6. Gender* Male 7. Ethnicity* African American Asian or Pacific Islander MONTH/DAY/YEAR Female Hispanic/Latino Native American White Other * Provision of this information is voluntary and will not affect consideration of application. Responses are solely for assessing compliance with civil rights laws. 8. Permanent Home Address NUMBER & STREET CITY / / / COUNTY COUNTY CODE (see p. 2) STATE ZIP CODE ( ) COUNTRY HOME TELEPHONE NUMBER 9. Current Mailing Address (if different from permanent) NUMBER & STREET CITY / / / COUNTY COUNTY CODE (see p. 2) STATE ZIP CODE ( ) ( ) ( ) COUNTRY HOME TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER CELL PHONE NUMBER 10. Chronological List of ALL Colleges and Universities Attended, including Temple University DATES ATTENDED NAME LOCATION MAJOR (month/year month/year) DEGREE AWARDED 1 Semester Applying for: Fall Spring Summer Year 1 Program/Curriculum (Use only the names provided on the Program/Degree Offerings grid.) 13. Degree Sought 14. Campus 15. Attendance Full-time (9 credit hours or more per semester) Day Part-time (fewer than 9 credit hours per semester) Evening 16. Have you previously applied to Temple? Undergraduate Yes No Graduate Yes No SD FEE FOR OFFICE USE ONLY / / DATE RECEIVED / / DEC RES DATE OFFICER / / / / / / / / / / / / UGPA 2 UGPA GGPA TOEFL TEST V Q T 17. Date on Which You Took/Will Take the Required Standardized Examination(s) GRE / / GMAT / / MAT / / TOEFL / /

7 18. Identification of Evaluators Providing References (if required) NAME TITLE AFFILIATION TELEPHONE 19. Work Experience (Include teaching, industrial, business, or other professional experience. Resume is optional.) DATES OF EMPLOYMENT COMPANY POSITION (month/year month/year) LOCATION TELEPHONE 20. Activities in Professional, Community, and Collegiate Organizations 2 Publications, Theses, Awards, and Creative Work 2 Statement of Professional Plans and Goals (Required of ALL Applicants) : On a separate sheet of 8½ x 11 paper, indicate your special interests within the discipline. Please note that the quality of your statement may be critically important for successful admission and a financial aid award. 23. Statement of Exceptional Circumstances (Optional) : On a separate sheet of 8½ x 11 paper, present any personal information that may assist the admissions committee in interpreting and evaluating your academic history and/or your academic credentials. 24. Statement of Residence (Required of ALL Applicants) Country of Citizenship Temple University reserves the right to request documentation in support of your claim of residency. Native Language U.S. Permanent Resident? Yes No Type of U.S. Visa (if alien): F1 J1 Other U.S. State of Legal Residence County If you claim Pennsylvania residency, will you have resided in Pennsylvania for 12 consecutive months preceding entry into Temple? Yes No If you claim Pennsylvania residency, have you been a student at any time during the past 12 months? Yes No If yes, what school, college, or university did you attend and where? If currently in military service, are you assigned to active duty at a military installation in Pennsylvania? Yes No If you are related to a military person assigned to active duty in Pennsylvania, indicate whether you are a: Spouse Dependent If you are a veteran and would like to receive information on support services for veterans, please check this box: I am now, and have been since, a legal resident of the state of. MONTH/YEAR ALL APPLICANTS MUST READ AND SIGN THE FOLLOWING STATEMENT: I understand that Temple University admissions personnel will have access to my Temple University student record and that withholding requested information or giving false information will make me ineligible for admission to the University and subject to dismissal if admitted. With this in mind, I certify that the above statements are correct and complete and, if admitted, I agree to abide by the published policies, rules, and regulations of Temple University. I further understand that from the time I file my application with the Graduate School, it is my responsibility to know all of the rules, requirements, and exemptions for my intended degree program. In the event that I am not admitted into the degree program for which I hereby apply, I understand that I will not be entitled to any tuition refund for any courses taken while my application was under consideration. Signature Date

Sex: Male Female Date of Birth: / / Native Language: (MM/DD/YYYY)

Sex: Male Female Date of Birth: / / Native Language: (MM/DD/YYYY) APPLICATION FORM FOR ADMISSION TO THE DOCTORAL PROGRAM Application Date Name (Mr., Ms.) (Last/Family Name) (First/Given Name) (M.I.) Previous Name (if applicable) (Last/Family Name) (First/Given Name)

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